7369 Conventional Vaginal Hysterectomy vs vNOTES Hysterectomy: A Retrospective Cohort Analysis of Two Techniques

Abstract

<h3>Study Objective</h3> The aim of this study was to compare the surgical outcomes in women undergoing a vaginal hysterectomy for abnormal uterine bleeding through a conventional vaginal hysterectomy (TVHH) vs. hysterectomy using the vaginal natural orifice transluminal endoscopic surgery (vNOTES) method. <h3>Design</h3> Retrospective cohort. <h3>Setting</h3> Tertiary academic center. <h3>Patients or Participants</h3> Seventy-eight patients with the diagnosis of abnormal uterine bleeding underwent a hysterectomy. Forty-five of them had a TVH and thirty-three of them had a hysterectomy via the vNOTES approach. <h3>Interventions</h3> A group of surgeons trained in conventional vaginal hysterectomy and vNOTES hysterectomy performed the surgeries from July 2017 to December 2021. <h3>Measurements and Main Results</h3> Our primary surgical outcomes were surgical time, rate of surgical complication, and blood loss. Average age for patients who underwent TVH was 41 years old and 41.2 for vNOTES; however, the average BMI for TVH was 31.7 and 30.8 for the vNOTES. 17% of the TVH group had a prior cesarean delivery (n=8) and 42.4% of them had a prior cesarean (n=14). The complications in the vNOTES group included three patients that required blood transfusions and one was readmitted within 30 days. All four of these patients had uteri weighing more than 100 g (102-840g) and one had a previous cesarean delivery. For the conventional group, nine cases resulted in complications including three blood transfusions, four patients with postoperative fever, one with a vaginal laceration and one ureteral injury. Three patients had a previous cesarean delivery and only two of them had a uterine larger than 100 g. <h3>Conclusion</h3> Overall vNOTES hysterectomies were faster and had lower complications compared to conventional vaginal hysterectomy; however, our analysis did not reach statistical significance. Patients in the vNOTES group had a higher proportion of prior cesareans and overall larger uteri, although less complications were noted. Randomized clinical trials are required to better characterize the findings of our study.